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Goharinejad S, Ahrari MN, Moulaei K, Sarafinejad A. Evaluating the effects of mobile application-based rehabilitation on improving disability and pain in patients with disputed thoracic outlet syndrome: A randomized controlled trial. Int J Med Inform 2024; 185:105400. [PMID: 38479190 DOI: 10.1016/j.ijmedinf.2024.105400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Disputed thoracic outlet syndrome (D.TOS) stands as one of the primary global contributors to physical disability, presenting diagnostic and treatment challenges for patients and frequently resulting in prolonged periods of pain and functional impairment. Mobile applications emerge as a promising avenue in aiding patient self-management and rehabilitation for D.TOS. This study aimed to investigate the impact of a certain mobile application-based rehabilitation on pain relief and the improvement of disability in patients experiencing D.TOS. METHODS Eighty-eight patients diagnosed with D.TOS randomized 1:1 to either the control group (n = 44) or the intervention group (n = 44). Participants in the control group were provided with a brochure containing standard rehabilitation exercise instructions, a written drug prescription from the physician, and guidance on recommended physical activity levels, including home exercises. In contrast, all participants in the intervention group used the mobile application. Disability and pain levels in patients were assessed after six weeks in both groups. RESULT Both groups improved pain and disability based on the scaled measurements. According to the questionnaire scale, the intervention group showed a considerable decline in disability; however, there was a significant difference in just one question (P < 0.05). Furthermore, the intervention group showed significant improvement in neck pain NRS (p = 0.024) compared to the control. Based on the shoulder and head pain numeric rate scale (NRSs), both groups showed improvement in disability conditions; but there were no significant differences between the groups (p > 0.05). CONCLUSION Mobile applications are promising tools for alleviating disabilities and pain in patients with musculoskeletal conditions. This study confirmed the potential of mobile technology to enhance active and corrective physical activity, thereby reducing pain in patients with D.TOS. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT) with the identifier IRCT20141221020380N3 (http://www.irct.ir/).
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Affiliation(s)
- Saeideh Goharinejad
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Naeem Ahrari
- Physical Medicine & Rehabilitation Specialist, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Khadijeh Moulaei
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Afshin Sarafinejad
- Clinical Informatics Research and Development Lab, Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran.
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Tsakotos G, Karampelias V, Chatziandreou I, Philippou D, Totlis T, Piagkou M. A Hypertrophic Anterior Scalene Muscle and the Passage of a Subclavian Artery Through its Fibres: The Location of Possible Entrapment. Acta Med Acad 2022; 51:212-216. [PMID: 36799314 PMCID: PMC10116174 DOI: 10.5644/ama2006-124.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/15/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE The presence of cervical ribs, 1st rib anomalies, cervical muscle hypertrophy and repetitive motion are possible aetiologies of subclavian artery (SCA) entrapment and/or compression. Thoracic outlet syndrome of the arterial type may appear with symptoms of hand pain due to the aneurismal part of the compressed SCA. The current cadaveric case describes a hypertrophic right-sided anterior scalene muscle (ASM) and the possible entrapment of the right SCA (RSCA) passing through its fibres. Furthermore, the branching pattern of the entrapped vessel is analysed. CASE REPORT A hypertrophic ASM was identified in the right infraclavicular area of a male Greek donated cadaver (70 years of age). The RSCA passed through the ASM belly, and some deeply situated fibres extended posteriorly to the RSCA. The ASM compressed the RSCA against the superior part of the 1st rib. CONCLUSION Knowledge of such variants may be important in the diagnosis of upper limb muscle atrophy or neurosensory loss.
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Affiliation(s)
- George Tsakotos
- Department of Anatomy, Medical School, Faculty of Health Sciences, National and Kapodistrian University of Athens.
| | - Vasilios Karampelias
- Department of Anatomy, Medical School, Faculty of Health Sciences, National and Kapodistrian University of Athens
| | - Ilenia Chatziandreou
- 1st Department of Internal Pathology, Medical School, Faculty of Health Sciences, National and Kapodistrian University of Athens
| | - Dimitrios Philippou
- Department of Anatomy, Medical School, Faculty of Health Sciences, National and Kapodistrian University of Athens
| | - Trifon Totlis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki
| | - Maria Piagkou
- Department of Anatomy, Medical School, Faculty of Health Sciences, National and Kapodistrian University of Athens
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Hock G, Johnson A, Barber P, Papa C. Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome. J Athl Train 2022:488563. [PMID: 36395374 DOI: 10.4085/1062-6050-138-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Thoracic outlet syndrome (TOS) involves an inconsistent set of symptoms that provides a challenge for medical providers to treat. Three categories of TOS are neurogenic, arterial, and venous. A combination of symptoms can occur and are most seen in overhead athletes. Symptoms may include pain, numbness, of an athlete to perform at their prior level of sport is impacted. Due to the variance in presentation and poor objective testing, there is not a well-defined examination process. It is suggested to perform an individualized assessment for each athlete. An athlete's medical team must communicate effectively as numerous specialists are usually involved to create a comprehensive treatment plan. Rehabilitation has been identified as a vital component in the recovery process. As an athletic trainer it is imperative to identify TOS and coordinate with the athlete's care team.
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Affiliation(s)
- Greg Hock
- Deparment of Sports Medicine Physical Therapy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew Johnson
- Department of Orthopedics and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patrick Barber
- Department of Orthopedics and Physical Performance, University of Rochester, Rochester, New York
| | - Cassidy Papa
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
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Motyl CM, Dohring C, Wang ML, Gosain S, France F, Poli J, Stoner MC, Doyle AJ. Opioid sparing effects of the bupivacaine pleural catheter in surgical decompression of the thoracic outlet. Ann Vasc Surg 2022; 88:283-290. [PMID: 36058460 DOI: 10.1016/j.avsg.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Rib resection in thoracic outlet decompression can result in significant postoperative pain requiring high levels of opioid medications. We evaluated the impact of a bupivacaine infusing pleural catheter on postoperative pain and opioid usage in patients undergoing rib resection for thoracic outlet syndrome. We hypothesized that delivery of local anesthetic via the pleural catheter would improve postoperative pain control compared to standard multimodal analgesia, and that the use of the catheter would decrease opioid use during the index hospitalization and prescriptions for opioid pain medications at discharge. METHODS We conducted a single-center retrospective cohort study of 26 patients who underwent rib resection for thoracic outlet decompression. Primary outcome was opioid consumption during the index hospitalization, measured in morphine milligram equivalents (MME). Secondary outcomes were MME prescribed at discharge and pain scores during the index hospitalization before and after the pleural drain and pleural catheter were removed. RESULTS Patients in the bupivacaine infusion pleural catheter group (n=11) had significantly lower milligram morphine equivalent (MME) usage during the index hospitalization (22.5 [1.9, 65.6] vs. 119.8 [76.5, 167.4]), and significantly lower MME prescribed at discharge (0 [0, 37.5] vs. 225 [183, 315]), compared to standard multimodal analgesia in controls (n=15). Only 3 patients in the bupivacaine pleural catheter group were discharged with any opioid prescriptions (27%), compared to 14 patients in the control group (93%). There was no difference in postoperative pain scores between groups before or after removal of the pleural drain, which was placed in all cases (p=0.31 and p=0.76, respectively). CONCLUSIONS Intraoperative placement of a bupivacaine infusion pleural catheter significantly reduced opioid use during the index hospitalization and opioid prescribing at discharge. Anesthetic infusion pleural catheters should be the treatment modality of choice for postoperative pain management in patients undergoing thoracic outlet decompression.
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Affiliation(s)
- Claire M Motyl
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Christian Dohring
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Maxwell L Wang
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Suparna Gosain
- Department of Anesthesiology, University of Rochester, Rochester, NY
| | - Fallon France
- Department of Anesthesiology, University of Rochester, Rochester, NY
| | - Joseph Poli
- Department of Anesthesiology, University of Rochester, Rochester, NY
| | - Michael C Stoner
- Division of Vascular Surgery, University of Rochester, Rochester, NY
| | - Adam J Doyle
- Division of Vascular Surgery, University of Rochester, Rochester, NY.
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Ajalat MJ, Pantoja JL, Ulloa JG, Cheng MJ, Patel RP, Chun TT, Gelabert HA. A Single Institution 30-Year Review of Abnormal First Rib Resection For Thoracic Outlet Syndrome. Ann Vasc Surg 2022; 83:53-61. [PMID: 34998937 DOI: 10.1016/j.avsg.2021.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/05/2021] [Accepted: 12/22/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Congenital abnormalities of the first rib (ABNFR) are a rare cause of thoracic outlet syndrome (TOS). The range of abnormalities have not been clearly documented in the literature. Surgical decompression in these patients presents with increased complexity secondary to anomalous anatomy. Our goal is to review an institutional experience of first rib resection (FRR) performed for ABNFRs, to present a novel classification system, and to analyze outcomes according to clinical presentation. METHODS A prospectively collected database was used to identify individuals with ABNFRs who underwent FRR for TOS between 1990-2021. These individuals were identified both by preoperative imaging and intraoperative descriptions of the first rib after resection. Demographic, clinical, perioperative and pathological data were reviewed. ABNFRs were classified into three categories according to anatomical criteria: (I) Hypoplastic, (II) Fused, and (III) Hyperplastic. Outcomes were rated using the standardized Quick Disability of Arm Shoulder and Hand Scores (QDS), Somatic Pain Scores (SPS) and Derkash Scores (DkS). RESULTS Among the 2200 cases of TOS, there were 19 patients (0.8%) with ABNFR who underwent FRR. Average age at surgery was 30.5 (range 11-74), including 13 men and 6 women. Presentations included 9 arterial (ATOS), 6 neurogenic (NTOS), and 4 venous (VTOS) cases. There were 6 class I, 6 class II, and 7 class III ABNFRs. Among 6 NTOS patients there were 4 abnormal nerve conduction tests and 5 positive anterior scalene muscle blocks. Among the 9 patients with ATOS, thrombolysis was attempted in 5 patients, and of these, 3 ultimately required surgical thrombectomy. Of 4 VTOS cases, 2 were managed with thrombolysis, and 2 with anticoagulation alone. The approach for FRR was transaxillary in all patients. Secondary procedures included 1 pectoralis minor tenotomy, 1 scalenectomy, and 1 contralateral rib resection. No major neurological or vascular complications occurred. There was 1 patient who required surgical evacuation of a hematoma. Intraoperative chest tube placement was required in 5 patients secondary to pleural entry during dissection. There was an overall improvement in symptoms over an average follow-up of 7.4 months. QDS reduced from 49.7 pre-op to 22.1 (p<.05). SPS improved from 3.4 pre-op to 1.8. DkS scores were good to excellent in 79% of patients. Residual symptoms were noted in 7, and ATOS accounted for 5 (70%) of these. All patients were able to return to work. CONCLUSIONS Despite increased complexity, ABNFRs may be safely resected via transaxillary approach with low incidence of complications, very good symptom relief, and excellent outcomes. Congenital ABNFRs may by classified into three categories (hypoplastic, fused, and hyperplastic) with a variety of presentations, including ATOS, NTOS, and VTOS. Classification of ABNFRs allows concise description of abnormal anatomy which facilitates comparison between series and provides direction for surgical management to ultimately optimize patient outcomes.
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Affiliation(s)
- Mark J Ajalat
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles.
| | - Joe L Pantoja
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles
| | - Jesus G Ulloa
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles
| | - Michael J Cheng
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles
| | - Rhusheet P Patel
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles
| | - Tristen T Chun
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles
| | - Hugh A Gelabert
- Division of Vascular and Endovascular Surgery, University of California, Los Angeles
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Saglam M, Firat T, Vardar-Yagli N, Calik-Kutukcu E, Delioglu K, Inal-Ince D, Tunc Y, Arikan H, Kayi-Cangir A. Respiratory Dysfunction in Individuals With Thoracic Outlet Syndrome. J Manipulative Physiol Ther 2020; 43:606-611. [PMID: 32829949 DOI: 10.1016/j.jmpt.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare pulmonary function and respiratory muscle strength and endurance in individuals with thoracic outlet syndrome (TOS) and healthy participants. METHODS Sixty-two individuals with TOS (mean age 30.81 ± 10.69 years; 10 male, 52 female) and 47 healthy individuals (mean age 30.64 ± 9.16 years; 14 male, 33 female) participated in this study. Pulmonary function testing was performed using a spirometer. Respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]) were measured using a mouth pressure device. Respiratory muscle endurance was tested at 35% MIP and measured as the time in seconds from the start of the test to voluntary exhaustion. RESULTS Age distribution and physical characteristics were similar between the groups (P > .05). All pulmonary function parameters except for peak expiratory flow rate were similar in patients with TOS and healthy controls (P > .05). Patients with TOS had significantly lower peak expiratory flow rate, MIP, MIP%, MEP, MEP%, and respiratory muscle endurance compared with controls (P < .05). Forty-six patients with TOS (74.2%) had MIP values below the lower limit of the 95% CI of the control group (97.05-113.88 cmH2O), and 53 patients with TOS (85.2%) had MEP values below the lower limit of the 95% CI of the control group (124.74-146.49 cmH2O). CONCLUSION Expiratory flow rate and respiratory muscle strength and endurance may be adversely affected in TOS. Trunk muscles perform both postural and breathing functions. Therefore, disruption in one function may negatively affect the other.
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Affiliation(s)
- Melda Saglam
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Tuzun Firat
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Kivanc Delioglu
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yasin Tunc
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Dessureault-Dober I, Bronchti G, Bussières A. Diagnostic Accuracy of Clinical Tests for Neurogenic and Vascular Thoracic Outlet Syndrome: A Systematic Review. J Manipulative Physiol Ther 2018; 41:789-99. [PMID: 30871714 DOI: 10.1016/j.jmpt.2018.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/02/2018] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To summarize the evidence on the accuracy of clinical tests to help confirm or refute a diagnosis of thoracic outlet syndrome (TOS). METHODS We searched 10 databases (January 1990 to February 2016) using relevant key words and medical subject headings terms. We considered diagnostic test accuracy studies comparing clinical tests for the diagnosis of TOS against a reference test. Cross-sectional, cohort, and case-control studies and randomized controlled trials were included. Risk of bias was appraised using QUADAS-2 and the Quality Appraisal of Reliability Studies checklist. We performed a qualitative synthesis of scientifically admissible studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used to report findings. RESULTS A total of 3932 articles were retrieved. After removal of duplicates, 1767 articles were screened for titles and abstract, leaving 494 articles for full-text review. Ten studies met the eligibility criteria and were assessed for risk of bias, 4 of which were included in the review. None of the included studies used the same index tests when comparing with a gold standard, and quality was poor. High clinical heterogeneity and the use of different comparators prevented from pooling results. Findings suggest that prescribing magnetic resonance imaging during provocative positioning to confirm a diagnosis of TOS may be useful. However, this is associated with a high false-positive rate of venous compression. CONCLUSION Little evidence currently supports the validity of clinical tests for the diagnosis of TOS. Future diagnostic accuracy studies should aim to use established methodological criteria and appropriate reporting guidelines to help validate clinical tests for diagnosing patients with TOS.
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Zdilla MJ, Aldawood AM, Plata A, Vos JA, Lambert HW. Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node. Autops Case Rep 2019; 9:e2018053. [PMID: 30863728 PMCID: PMC6394356 DOI: 10.4322/acr.2018.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically - a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.
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Affiliation(s)
- Matthew J Zdilla
- West Liberty University, Department of Natural Sciences & Mathematics and Graduate Health Sciences. West Liberty, West Virginia, USA.,West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA.,West Liberty University, Department of Graduate Health Sciences. West Liberty, West Virginia, USA
| | - Ali M Aldawood
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - Andrew Plata
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - H Wayne Lambert
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
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Affiliation(s)
| | | | - Ying Wei Lum
- The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Mattox R, Battaglia PJ, Welk AB, Maeda Y, Haun DW, Kettner NW. Reference Values for the Scalene Interval Width During Varying Degrees of Glenohumeral Abduction Using Ultrasonography. J Manipulative Physiol Ther 2016; 39:662-667. [PMID: 28327294 DOI: 10.1016/j.jmpt.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 05/04/2016] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to establish reference values for the width of the interval between the anterior and middle scalene muscles using ultrasonography during varying degrees of glenohumeral joint (GH) abduction. Reliability and body mass index (BMI) data were also assessed. METHODS Interscalene triangles of asymptomatic participants were scanned bilaterally in the transverse plane. Images were obtained at 0°, 90°, and 150° of GH abduction with the participant seated. Width measurements were taken between the anterior and middle scalene muscle borders by bisecting the C6 nerve root as it passed superficial to the posterior tubercle of the C7 transverse process. Intra- and interexaminer reliability and BMI correlation were studied. Statistical significance was defined as P ≤ .05. RESULTS Images of 42 scalene intervals were included from 21 participants (11 female). Mean participant age was 25.3 ± 3.9 years; mean BMI was 25.4 ± 2.7 kg/m2. Scalene interval measurements at 0°, 90°, and 150° of GH abduction were 4.5 ± 0.5 mm, 4.6 ± 0.5 mm, and 4.4 ± 0.7 mm, respectively, without a significant difference (P = .07). Intraexaminer reliability was excellent (0°: intraclass correlation coefficient [ICC] = 0.82; 90°: ICC = 0.89; 150°: ICC = 0.90). Interexaminer reliability was good to excellent (0°: ICC = 0.59; 90°: ICC = 0.85; 150°: ICC = 0.89). Body mass index was positively correlated only at 0° of GH abduction. CONCLUSIONS This study establishes previously unreported reference ultrasonography values for the width of the scalene interval. Intraexaminer reliability was excellent at all glenohumeral positions, and interexaminer reliability was determined to be good to excellent. Body mass index was positively correlated only at 0° of GH abduction.
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Affiliation(s)
- Ross Mattox
- Department of Radiology, Logan University, Chesterfield, MO.
| | | | - Aaron B Welk
- Department of Radiology, Logan University, Chesterfield, MO
| | - Yumi Maeda
- Department of Radiology, Logan University, Chesterfield, MO; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Daniel W Haun
- Department of Radiology, Logan University, Chesterfield, MO
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Sadeghi R, Safi M. Systemic thrombolysis in the upper extremity deep vein thrombosis. ARYA Atheroscler 2011; 7:40-6. [PMID: 22577443 PMCID: PMC3347843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/03/2011] [Indexed: 11/04/2022]
Abstract
Almost 4% of all patients with venous thrombosis have upper extremity deep vein thrombosis (UEDVT) and the incidence of UEDVT increases over time. The frequency of post-thrombotic syndrome (PTS) after UEDVT is not low and upper extremity PTS is a potentially major morbidity that adversely affects quality of life, particularly if the dominant arm is involved. We discuss briefly the role of thrombolytic therapy in the treatment of upper extremity deep vein thrombosis and also the role of systemic thrombolysis in selected patients.
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Affiliation(s)
- Roxana Sadeghi
- Assistant Professor of Cardiology, Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences (SUMS), Tehran, Iran
| | - Morteza Safi
- Assistant Professor of Cardiology, Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences (SUMS), Tehran, Iran
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